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1.
Cad Saude Publica ; 36(6): e00115320, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32578805

RESUMO

This study aims to analyze the pressure on the Brazilian health system from the additional demand created by COVID-19. The authors performed a series of simulations to estimate the demand for hospital beds (health micro-regions) as well as to ICU beds, and mechanical ventilators (health macro-regions) under different scenarios of intensity (infection rates equivalent to 0.01, 0.1, and 1 case por 100 inhabitants) and time horizons (1, 3, and 6 months). The results reveal a critical situation in the system for meeting this potential demand, with numerous health micro-regions and macro-regions operating beyond their capacity, compromising the care for patients, especially those with more severe symptoms. The study presents three relevant messages. First, it is necessary to slow the spread of COVID-19 in the Brazilian population, allowing more time for the reorganization of the supply and relieve the pressure on the health system. Second, the expansion of the number of available beds will be the key. Even if the private sector helps offset the deficit, the combined supply from the two sectors (public and private) would be insufficient in various macro-regions. The construction of field hospitals is important, both in places with a history of "hospital deserts" and in those already pressured by demand. The third message involves the regionalized organization of health services, whose design may be adequate in situations of routine demand, but which suffer additional challenges during pandemics, especially if patients have to travel long distances to receive care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Pneumonia Viral/epidemiologia , Ventiladores Mecânicos/provisão & distribução , Brasil/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
2.
PLoS One ; 15(4): e0231792, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298356

RESUMO

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.


Assuntos
Disparidades nos Níveis de Saúde , Classe Social , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Emprego , Feminino , Finlândia/epidemiologia , Humanos , Renda/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Sistema de Registros , Fatores Socioeconômicos
3.
MMWR Morb Mortal Wkly Rep ; 69(3): 72-76, 2020 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-31971934

RESUMO

Infants are at increased risk for pertussis-associated morbidity and mortality, and pregnant women and their infants are more likely than other patient populations to experience severe influenza-related illness (1,2). The Advisory Committee on Immunization Practices (ACIP) recommends that all women receive the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during each pregnancy, preferably during the early part of gestational weeks 27-36 (3). ACIP also recommends that women who are or might be pregnant during the influenza season receive the inactivated influenza vaccine at any time during pregnancy (4). Despite these recommendations, coverage with Tdap and influenza vaccines during pregnancy has been low, with approximately one half of women receiving each vaccine and only one third receiving both, based on a survey during March-April 2019 (5). Data obtained through a retrospective chart review of randomly selected pregnant women who delivered at the University of Florida Health Shands Hospital in Gainesville, Florida, from January 1, 2016, to December 31, 2018, were analyzed to assess vaccination coverage by insurance type. Because the Florida Medicaid policy at that time did not cover these vaccines during pregnancy, the hospital system offered Tdap and influenza vaccines at no additional cost to mothers during the immediate postpartum hospital stay. Among 341 women, 68.6% of privately insured and 13.4% with Medicaid received Tdap during pregnancy, and among 316 women, 70.4% of privately insured and 35.6% with Medicaid received influenza vaccine during pregnancy. Many women, especially those with Medicaid, were vaccinated in the immediate postpartum period, when vaccination was available at no cost, increasing Tdap vaccination rates to 79.3% for privately insured and 51.7% for women with Medicaid; influenza vaccination rates rose to 72.0% for privately insured and 43.5% for women with Medicaid. These data suggest that the state Medicaid policy to not cover these vaccines during pregnancy might have significantly reduced coverage among its enrollees.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Seguro Saúde/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adolescente , Adulto , Feminino , Florida , Humanos , Medicaid/estatística & dados numéricos , Gravidez , Setor Privado/estatística & dados numéricos , Estados Unidos , Adulto Jovem
4.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31911477

RESUMO

BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.


Assuntos
Children's Health Insurance Program/normas , Medicaid/normas , Setor Privado/normas , Setor Público/normas , Seguro de Saúde Baseado em Valor , Adolescente , Criança , Pré-Escolar , Children's Health Insurance Program/estatística & dados numéricos , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Estados Unidos , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
5.
Ann Otol Rhinol Laryngol ; 129(4): 369-375, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31752501

RESUMO

OBJECTIVE: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). METHODS: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. RESULTS: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. CONCLUSIONS: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. LEVEL OF EVIDENCE: 2c.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Otolaringologia , Otorrinolaringopatias , Procedimentos Cirúrgicos Otorrinolaringológicos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Encaminhamento e Consulta , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/normas , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento , Estados Unidos/epidemiologia
6.
Medicina (B Aires) ; 79(6): 461-467, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829948

RESUMO

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico por imagem , Distribuição por Idade , Idoso , Argentina/epidemiologia , Angiografia Coronária/métodos , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Hemodinâmica , Humanos , Hipertensão/epidemiologia , Laboratórios/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição por Sexo , Fumar/epidemiologia , Estatísticas não Paramétricas
7.
Health Policy Plan ; 34(Supplement_3): iii20-iii26, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816074

RESUMO

Policies to improve access to medicines for children in low- and middle-income countries, such as Nigeria, should consider the growing threat of non-communicable diseases. The aim of this pilot study was to scope availability, price and affordability of essential cardiovascular medicines for children in selected states in Nigeria. The study was a descriptive longitudinal survey conducted in three phases. Availability was determined as percentage of facilities having the medicine on the survey date. Medicines with good availability (>80%) were noted. Prices were cross-referenced against international Reference Prices and the Nigerian National Health Insurance Scheme Prices. Affordability was calculated using the Least-Paid Government Worker method. For medicines compounded to improve availability, a model for calculating affordability was proposed. In Phase I, the availability of all 17 strengths of the cardiovascular medicines or diuretics listed in the Essential Medicines List for Children (2015) were surveyed in two conveniently selected states using the WHO/HAI questionnaire. Data were collected from 17 hospitals and pharmacies. Phases II and III focused on tablet formulations (enalapril, furosemide, hydrochlorothiazide and spironolactone) in three purposively selected state capitals: Lagos, Abuja and Yenagoa. In Phase II, 11 private pharmacies were surveyed in December 2016: Phase III tracked price changes in Abuja and Yenagoa in August 2018. Only furosemide and hydrochlorothiazide tablets had good availability. Oral liquids were unavailable. Prices for four generic oral tablets were 2-16× higher than the International Reference Prices; prices for two of these did not change significantly over the study period. Affordable medicines were generic furosemide and hydrochlorothiazide tablet. Where a fee is charged, compounded medicines were also not affordable. While the small sample sizes limit generalization, this study provides indicative data suggesting that prices for cardiovascular medicines remain high and potentially unaffordable in the private sector in these selected states, and when compounded. Regular systematic access surveys are needed.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Custos e Análise de Custo/estatística & dados numéricos , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Criança , Composição de Medicamentos/estatística & dados numéricos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Nigéria , Farmácias/estatística & dados numéricos , Projetos Piloto , Setor Privado/estatística & dados numéricos , Inquéritos e Questionários
8.
Malar J ; 18(1): 408, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31806025

RESUMO

BACKGROUND: Haiti and the Dominican Republic (DR) are targeting malaria elimination by 2022. The private health sector has been relatively unengaged in these efforts, even though most primary health care in Haiti is provided by non-state actors, and many people use traditional medicine. Data on private health sector participation in malaria elimination efforts are lacking, as are data on care-seeking behaviour of patients in the private health sector. This study sought to describe the role of private health sector providers, care-seeking behaviour of individuals at high risk of malaria, and possible means of engaging the private health sector in Hispaniola's malaria elimination efforts. METHODS: In-depth interviews with 26 key informants (e.g. government officials), 62 private providers, and 63 patients of private providers, as well as 12 focus group discussions (FGDs) with community members, were conducted within seven study sites in Haiti and the DR. FGDs focused on local definitions of the private health sector and identified private providers for interview recruitment, while interviews focused on private health sector participation in malaria elimination activities and treatment-seeking behaviour of febrile individuals. RESULTS: Interviews revealed that self-medication is the most common first step in the trajectory of care for fevers in both Haiti and the DR. Traditional medicine is more commonly used in Haiti than in the DR, with many patients seeking care from traditional healers before, during, and/or after care in the formal health sector. Private providers were interested in participating in malaria elimination efforts but emphasized the need for ongoing support and training. Key informants agreed that the private health sector needs to be engaged, especially traditional healers in Haiti. The Haitian migrant population was reported to be one of the most at-risk groups by participants from both countries. CONCLUSION: Malaria elimination efforts across Hispaniola could be enhanced by engaging traditional healers in Haiti and other private providers with ongoing support and trainings; directing educational messaging to encourage proper treatment-seeking behaviour; and refining cross-border strategies for surveillance of the high-risk migrant population. Increasing distribution of rapid diagnostic tests (RDTs) and bi-therapy to select private health sector facilities, accompanied by adopting regulatory policies, could help increase numbers of reported and correctly treated malaria cases.


Assuntos
Erradicação de Doenças/estatística & dados numéricos , Malária Falciparum/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Setor Privado/estatística & dados numéricos , Adulto , Idoso , República Dominicana , Feminino , Grupos Focais , Haiti , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
9.
S Afr Med J ; 109(12): 934-940, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865955

RESUMO

BACKGROUND: In South Africa (SA), the National Department of Health has developed an Antimicrobial Resistance National Strategy Framework document to manage antimicrobial resistance (AMR). One of the strategic objectives is to optimise surveillance and early detection of AMR. At the National Institute for Communicable Diseases (NICD), an analysis of selected organisms and antimicrobial agents from both the public and the private sectors was conducted. OBJECTIVES: The relevance of surveillance for AMR is increasingly recognised in the light of global action plans to combat resistance. In this report, we present an overview of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) organisms and Escherichia coli reported from public and private sector laboratories in SA for the period 2016 - 2017. METHODS: Antimicrobial susceptibility testing (AST) profiles on selected ESKAPE organisms and E. coli isolated from blood cultures from the public and private sectors in 2016 and 2017 were analysed. AST data were extracted from a web-based electronic platform created by the NICD. Drug-bug combinations following the World Health Organization's Global Antimicrobial Surveillance System guidelines were included in the analysis. RESULTS: A total of 28 920 ESKAPE organisms and E. coli were reported in 2016 and 32 293 in 2017 across the two health sectors. Proportions of some organisms differed between the two health sectors, such as E. coli (19% in the public sector and 36% in the private sector), A. baumannii (14% public and 4% private), P. aeruginosa (7% public and 11% private) and S. aureus (27% public and 17% private). Susceptibility data indicated changing patterns in both sectors towards an increase in non-susceptibility to carbapenems in K. pneumoniae (p<0.01). However, we demonstrated an increase in susceptibility to cloxacillin in S. aureus (p<0.01) in both sectors. CONCLUSIONS: The key clinically important finding is the rapidly decreasing carbapenem susceptibility among Enterobacteriaceae reported in SA, irrespective of sector. In addition, the analysis provides information that could be used to monitor the effectiveness of interventions implemented at a national level under the guidance and direction of the national AMR framework.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Farmacorresistência Bacteriana , Vigilância da População , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Acinetobacter baumannii/efeitos dos fármacos , Hemocultura , Enterobacter/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , África do Sul , Staphylococcus aureus/efeitos dos fármacos
10.
BMC Health Serv Res ; 19(1): 973, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852546

RESUMO

BACKGROUND: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Doenças Cardiovasculares/tratamento farmacológico , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Líbano , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Catar , Inquéritos e Questionários
11.
Tunis Med ; 97(3): 438-444, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31729718

RESUMO

INTRODUCTION: The evaluation of occupational exposures allows to guide preventive strategies and to suggest adequate solutions. AIM: Identify occupational exposures and constrains among workers of private sector in Tunisia. METHODS: A descriptive study including all companies of the private sector who are adhering to a service of occupational health of 17 Tunisian governorates. The survey was exhaustive for the services having less than 500 companies and by sampling for the services with more than 500.The data collection was based on data sheet completed by the occupational physician. RESULTS: This investigation concerned 1653 companies employing 161 517 employees. The industrial sector represented 52.8 %.Small and medium-sized enterprises represented 92.6 % of the studied companies. Companies having a committee of Health and Safety at work represented 16.82 % and 22.14 % had a safety officer. Posturales constraints are the most represented exposures (56%) followed by gestural constraints (27%). Heavy lifting concerned 17% of workers. Exposure to noise represented the third professional nuisance, 23% of employees are exposed. The employees exposed to organic solvents were among 16695 (10.34 %), distributed on 685 companies. CONCLUSION: This study allowed us to identify and to rank the professional exposures and constrains in the Tunisian private sector. This could lead to improving targeted strategies of prevention occupational risks.


Assuntos
Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Estudos Transversais , Feminino , Empregados do Governo/estatística & dados numéricos , Humanos , Masculino , Doenças Profissionais/classificação , Exposição Ocupacional/classificação , Saúde do Trabalhador/normas , Ocupações/classificação , Ocupações/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Tunísia/epidemiologia
12.
Acta Med Port ; 32(11): 697-705, 2019 Nov 04.
Artigo em Português | MEDLINE | ID: mdl-31703182

RESUMO

INTRODUCTION: The aim of this study is to characterize and assess work-family balance within the medical profession in Portugal. MATERIAL AND METHODS: This cross-sectional and exploratory study analyzed a sample of 181 doctors who are members of the Portuguese Catholic Doctors' Association. A qualitative survey with multiple-choice questions was applied in order to assess socioeconomic and working conditions as well as work-family balance. Descriptive and linear regression analyses were carried out. RESULTS: Nearly 40% of the surveyed doctors negatively assessed the work-family balance within the private sector. As for the Portuguese National Health System, 73% negatively assessed the work-family balance within the public sector. More than half of those surveyed (56%) worked more hours than what they considered as harmful for their work-family balance and the vast majority was working at the limit or overtime. Data collected enabled us to associate a heavier workload with working in the emergency room, age and men. Moreover, it was observed that working more hours was not linked to having children or being married. DISCUSSION: In our study, the three measures of work-family balance that the participants considered to be the most important were the possibility of flexible scheduling, part-time work and temporarily reducing working hours (e.g. for family assistance). These aspects may explain the differences found in the assessment of work-family balance between the public and private sector. CONCLUSION: Due to the demanding nature of the medical profession, doctors are placed into a particularly risky situation in order to achieve a suitable work-family balance. The results of our study indicate a general dissatisfaction regarding this balance - special in the public sector - which is mainly associated with excessive weekly working hours.


Assuntos
Médicos/estatística & dados numéricos , Equilíbrio Trabalho-Vida , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Médicas/psicologia , Médicas/estatística & dados numéricos , Portugal , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Pesquisa Qualitativa , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Tolerância ao Trabalho Programado , Equilíbrio Trabalho-Vida/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
13.
Pan Afr Med J ; 34: 16, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762885

RESUMO

Introduction: Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria. Methods: SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05. Results: Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10-3) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10-3). Conclusion: In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention.


Assuntos
Assistência à Saúde/organização & administração , Instalações de Saúde/estatística & dados numéricos , Malária/terapia , Antimaláricos/administração & dosagem , Costa do Marfim , Estudos Transversais , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
14.
Pan Afr Med J ; 34: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762925

RESUMO

Introduction: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.


Assuntos
Equipamentos e Provisões/provisão & distribução , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Radiografia/instrumentação , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Zimbábue
15.
J Bone Joint Surg Am ; 101(22): 2044-2050, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31764367

RESUMO

BACKGROUND: Racial and ethnic disparities in hospital readmissions following total joint arthroplasty present opportunities for reducing cost and improving health equity. Despite efforts to reduce readmissions following total joint arthroplasty in the general population, no studies have documented the impact of these efforts on racial and ethnic disparities in total joint arthroplasty readmissions. The purpose of this study was to determine whether comprehensive efforts to reduce hospital readmissions following total joint arthroplasty have impacted racial and ethnic disparities in readmission rates during the period from 2005 to 2015. METHODS: We conducted a retrospective analysis comparing patients readmitted and not readmitted to the hospital within 30 days of a total joint arthroplasty by estimating logistic regression models for clustered data using generalized estimating equations (GEEs) in R. Connecticut hospital discharge data for patients admitted for International Classification of Diseases, Ninth Revision (ICD-9) procedure codes 81.51 and 81.54 (Current Procedural Terminology [CPT] codes 27130 and 27447) during the 2005 to 2015 U.S. Centers for Medicare & Medicaid Services (CMS) fiscal years were analyzed. Models included quadratic terms to capture nonlinear time trends in readmissions, as well as terms for the statistical interaction between race or ethnicity and both the linear and quadratic time trends in predicting the odds of readmission. RESULTS: There were 102,510 total admissions to Connecticut hospitals for total joint arthroplasty from 2005 to 2015. The 30-day (all-cause) readmission rate declined from 5.1% in 2005 to 3.6% in 2015, with a steeper downward trend observed from 2009 to 2015. The results from logistic models indicated that black patients (odds ratio [OR], 1.68; p < 0.0001) and Hispanic patients (OR, 1.48; p < 0.0001) were significantly more likely to be readmitted within 30 days of discharge following a total joint arthroplasty than white patients over the study period. The significant interaction of black race and the quadratic time trend in models capturing nonlinear trends in readmission over time indicated that the readmission rates for black patients increased compared with those for white patients from 2005 through 2008 and decreased relative to those for white patients from 2009 to 2015 (OR, 0.24; p = 0.030). CONCLUSIONS: Data from Connecticut hospitals show that 30-day readmissions following a total joint arthroplasty declined by 1.5 percentage points from 2005 to 2015, and that this decline was much more pronounced among black patients, resulting in the narrowing of racial disparities in readmission following a surgical procedure. CLINICAL RELEVANCE: Racial and ethnic minorities have historically been at increased risk for complications and readmission following hospital-based surgical care. This analysis of readmission following total joint arthroplasty reveals that such disparities are remediable and should foster further research on the primary drivers of and remedies for readmission disparities.


Assuntos
Afro-Americanos/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/estatística & dados numéricos , Criança , Pré-Escolar , Connecticut/epidemiologia , Feminino , Humanos , Lactente , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Setor Privado/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
16.
PLoS One ; 14(10): e0224215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31648234

RESUMO

INTRODUCTION: Half of all Ugandans (49%) turn to the private or private-not-for-profit (PNFP) sectors when faced with illness, yet little is known about the capacity of these sectors to deliver surgical services. We partnered with the Ministry of Health to conduct a nationwide mixed-methods evaluation of private and PNFP surgical capacity in Uganda. METHODS: A standardized validated facility assessment tool was utilized to assess facility infrastructure, service delivery, workforce, information management, and financing at a randomized nationally representative sample of 16 private and PNFP hospitals. Semi-structured interviews were conducted to qualitatively explore facilitating factors and barriers to surgical, obstetric and anaesthesia (SOA) care. Hospitals walk-throughs and retrospective reviews of operative logbooks were completed. RESULTS: Hospitals had a median of 177 beds and two operating rooms. Ten hospitals (62.5%) were able to perform all Bellwether procedures (cesarean section, laparotomy and open fracture treatment). Thirty-day surgical volume averaged 102 cases per facility. While most hospitals had electricity, oxygen, running water, and necessary equipment, many reported pervasive shortages of blood, surgical consumables, and anesthetic drugs. Several themes emerged from the qualitative analysis: (1) geographic distance and limited transportation options delay reaching care; (2) workforce shortages impede the delivery of surgical care; (3) emergency and obstetric volume overwhelm the surgical system; (4) medical and non-medical costs delay seeking, reaching, and receiving care; and (5) there is poor coordination of care with insufficient support systems. CONCLUSION: As in Uganda's public sector, barriers to surgery in private and PNFP hospitals in Uganda are cross-cutting and closely tied to resource availability. Critical policy and programmatic developments are essential to build and strengthen Ugandan surgical capacity across all sectors.


Assuntos
Assistência à Saúde , Recursos em Saúde/provisão & distribução , Acesso aos Serviços de Saúde/economia , Setor Privado/estatística & dados numéricos , Cirurgiões/provisão & distribução , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Anestesiologia , Bancos de Sangue , Cesárea/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/provisão & distribução , Feminino , Humanos , Laparotomia/estatística & dados numéricos , Organizações sem Fins Lucrativos , Gravidez , Estudos Retrospectivos , Uganda
17.
Salud Publica Mex ; 61(5): 637-647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31661741

RESUMO

OBJECTIVE: This study aimed to compare the performance in the National Assessment for Applicants for Medical Resi- dency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. MATERIALS AND METHODS: Cross-sectional study based on historical data (2001-2017). We use summary measures and colourfilled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. RESULTS: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36, p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). CONCLUSIONS: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Faculdades de Medicina/estatística & dados numéricos , Área Sob a Curva , Humanos , México , Curva ROC , Faculdades de Medicina/provisão & distribução , Fatores Socioeconômicos , Estatísticas não Paramétricas
18.
Int J Tuberc Lung Dis ; 23(10): 1090-1099, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627774

RESUMO

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.


Assuntos
Antituberculosos/administração & dosagem , Vacina BCG/administração & dosagem , Programas de Rastreamento/estatística & dados numéricos , Tuberculose/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Tardio , Feminino , Humanos , Índia , Lactente , Masculino , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Tempo para o Tratamento , Tuberculose/tratamento farmacológico , Adulto Jovem
19.
Ethiop J Health Sci ; 29(3): 401-408, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447509

RESUMO

Background: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme. Methods: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1st July 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country. Results: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111). Conclusion: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana.


Assuntos
Medicamentos Essenciais/provisão & distribução , Programas Nacionais de Saúde/organização & administração , Farmácias/organização & administração , Gana , Humanos , Programas Nacionais de Saúde/estatística & dados numéricos , Nigéria , Farmácias/estatística & dados numéricos , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos
20.
Toxicol Ind Health ; 35(8): 558-566, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31462195

RESUMO

The absence of studies that investigate the causes and risk factors of nonfatal occupational injury in Tunisia inhibits the development of effective preventive strategies. The objective of this study was to identify the causes and risk factors of nonfatal occupational injury in the private sector in Tunisia. We used retrospective data derived from the occupational injury reporting forms submitted to the Caisse Nationale d'Assurance Maladie. A sample of 42,293 workers in the private sector for 2014 contains information on sociodemographic variables. Multivariable Poisson regression was used to investigate the association of cause-specific injury with demographic variables. The leading causes of nonfatal occupational injury were "falls" (employee fall and falling objects; 36%) and "struck by objects" (23%). Male employees were at higher risk of "exposure to extreme temperatures" (PR = 12 [7-45]), "asphyxia and poisoning" (PR = 4 [2.4-12]), "transport and handling" (PR = 2.4 [1.9-5]), "falling objects" (PR = 2.3 [1.4-3.7]), and "employee fall" (PR = 1.2 [1.1-1.5]). Although, rural areas were at higher risk to "asphyxia and poisoning" (PR = 3.6 [1.1-11.4]), "transport and handling" (PR = 2.5 [1.3-5.4]), and "burns" (PR = 1.3 [1.1-3]). It is important that effective interventions be developed to minimize the impact of falls and "struck by objects." The most vulnerable categories to occupational injury are less educated men, rural residents aged between 15 years and 24 years, and elderly employees (55 years and over). Thus, our findings can contribute to the planning of prevention intervention programs that should expand to the most vulnerable categories.


Assuntos
Traumatismos Ocupacionais/etiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Asfixia/epidemiologia , Asfixia/etiologia , Estudos Transversais , Feminino , Golpe de Calor/epidemiologia , Golpe de Calor/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/epidemiologia , Envenenamento/epidemiologia , Envenenamento/etiologia , Distribuição de Poisson , Setor Privado/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Tunísia/epidemiologia , Adulto Jovem
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